Provider Demographics
NPI:1013200872
Name:JACKSON, DAVID MORRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MORRIS
Last Name:JACKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 ORCHARD PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80023-9206
Mailing Address - Country:US
Mailing Address - Phone:720-627-3761
Mailing Address - Fax:
Practice Address - Street 1:835 E 18TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218
Practice Address - Country:US
Practice Address - Phone:303-825-4646
Practice Address - Fax:303-825-3215
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49065208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42274826Medicaid
COCOAAA3500Medicare PIN